Cystectomy Surgery in Singapore | Bladder Cancer Treatment

Cystectomy is a surgical procedure that involves removing all or part of the urinary bladder. This surgery is primarily performed to treat bladder cancer that has invaded the muscle wall or has a high risk of progression. The procedure may also be necessary for other conditions such as severe bladder dysfunction, interstitial cystitis that hasn’t responded to other treatments, or bladder damage from radiation or other causes.

There are two main types of cystectomy: partial cystectomy, where only a portion of the bladder is removed, and radical cystectomy, where the entire bladder is removed along with nearby lymph nodes. In radical cystectomy for men, the prostate and seminal vesicles are typically removed. For women, the procedure may include removal of the uterus, ovaries, fallopian tubes, and part of the vaginal wall, depending on the extent of the disease.

When the entire bladder is removed, surgeons create a new way for urine to leave the body, called a urinary diversion. The specific approach depends on various factors including the patient’s overall health, cancer stage, and personal preferences. Consulting a bladder specialist in Singapore supports appropriate planning and decision-making. Modern surgical techniques have significantly improved both the functional and quality-of-life outcomes for patients undergoing cystectomy.

Ideal Candidates

• Patients with muscle-invasive bladder cancer (stage T2 or higher)
• Individuals with high-grade non-muscle invasive bladder cancer that hasn’t responded to BCG therapy
• Patients with recurrent bladder tumours despite previous treatments
• Those with extensive carcinoma in situ (CIS) of the bladder
• Individuals with bladder cancer causing symptoms like bleeding that cannot be controlled by other means
• Patients with non-functioning bladders due to radiation damage or other causes
• Generally healthy individuals who can tolerate major surgery
• Patients committed to post-surgery rehabilitation and lifestyle adjustments

Contraindications

• Severe heart or lung disease that makes general anaesthesia high-risk
• Extensive metastatic disease where surgery wouldn’t improve prognosis
• Blood clotting disorders that cannot be adequately managed
• Active infections that need treatment before surgery
• Severe cognitive impairment preventing post-operative self-care
• Certain anatomical factors that make urinary diversion creation impossible

The decision to proceed with cystectomy requires careful evaluation by your MOH-accredited urologist. They will assess your overall health status, cancer characteristics, and individual circumstances to determine if this surgery is appropriate for your situation.

Open Radical Cystectomy

Open cystectomy involves making an incision in the lower abdomen to access and remove the bladder. This traditional approach provides direct visualisation and access to the surgical area, allowing for thorough removal of the bladder and surrounding tissues. The surgeon can also perform extensive lymph node dissection, which is crucial for accurate cancer staging and treatment. This technique remains the standard approach for complex cases or when extensive reconstruction is needed.

Minimally Invasive Cystectomy

Laparoscopic and robot-assisted cystectomy use several small incisions instead of one large incision. The surgeon operates using specialised instruments and a camera system that provides magnified, high-definition views of the surgical area. Robot-assisted surgery offers enhanced precision with wristed instruments that provide greater dexterity than traditional laparoscopic tools. These minimally invasive approaches typically result in less blood loss, reduced post-operative pain, and shorter hospital stays, though the cancer control outcomes are comparable to open surgery.

Urinary Diversion Options

After bladder removal, surgeons create one of three types of urinary diversions. An ileal conduit uses a piece of intestine to create a passage for urine to flow from the kidneys to a stoma (opening) on the abdomen, where it collects in an external bag. A continent cutaneous diversion creates an internal pouch from intestinal segments that patients empty by catheterisation through a stoma. A neobladder reconstruction uses intestinal tissue to create a new bladder-like reservoir that connects to the urethra, allowing near-normal urination.

Pre-Treatment Preparation

Before cystectomy, patients undergo comprehensive evaluation including blood tests, imaging studies (CT scans, MRI), and cardiac assessment to ensure fitness for surgery. Nutritional optimisation may be recommended, as good nutrition supports healing. Patients typically begin bowel preparation one to two days before surgery with clear liquids and prescribed laxatives. Smoking cessation is strongly encouraged at least four weeks before surgery to improve healing. Pre-operative education sessions help patients understand the procedure, recovery process, and how to manage their urinary diversion. Arrangements should be made for post-discharge support at home.

During the Procedure

On surgery day, patients receive general anaesthesia and epidural anaesthesia for post-operative pain control. The procedure typically takes 4-6 hours, depending on the complexity and type of urinary diversion created. The surgeon removes the bladder and performs lymph node dissection to check for cancer spread. For urinary diversion creation, a segment of intestine is isolated and reconfigured according to the chosen diversion type. The remaining intestine is reconnected to restore normal bowel function. Drains are placed to prevent fluid accumulation, and a nasogastric tube may be inserted temporarily.

Immediate Post-Treatment

Patients typically spend the first 24-48 hours in a high-dependency unit for close monitoring. Pain management includes epidural anaesthesia, patient-controlled analgesia, and oral medications as needed. Early mobilisation begins within 24 hours to prevent complications like blood clots and pneumonia. The nasogastric tube is usually removed once bowel function returns. Patients gradually progress from clear liquids to solid foods over several days. Stoma care education begins for those with ileal conduits, while neobladder patients learn pelvic floor exercises.

First 24-48 Hours

Immediate post-operative care focuses on pain control, monitoring vital signs, and preventing complications. Patients have multiple tubes and drains that are gradually removed as healing progresses. Respiratory exercises and incentive spirometry help prevent pneumonia. Early walking with assistance reduces the risk of blood clots. Urine output is closely monitored through catheters or stoma drainage. The surgical team watches for signs of infection, bleeding, or other complications that require immediate attention.

First Week

During the hospital stay, which typically lasts 7-10 days, patients progressively increase their activity level. Diet advances from liquids to regular food as bowel function returns. For ileal conduit patients, stoma care training intensifies with hands-on practice. Continent diversion patients learn catheterisation techniques. Pain medication is adjusted from intravenous to oral forms. Physical therapy helps regain strength and mobility. Patients and caregivers receive education about home care, recognising complications, and when to seek medical attention.

Long-term Recovery

Complete recovery takes 6-12 weeks, with gradual return to normal activities. Heavy lifting restrictions continue for 6-8 weeks to allow proper healing. Patients with neobladders undergo training to regain urinary control, which may take several months. Regular follow-up appointments monitor for complications and cancer recurrence. Imaging studies and cystoscopy (for partial cystectomy or neobladder patients) are performed periodically. Nutritional counselling helps manage any dietary changes related to intestinal surgery. Support groups provide emotional assistance during adjustment to life after cystectomy.

Cystectomy surgery offers significant benefits for patients with bladder cancer and other serious bladder conditions. The primary benefit is effective cancer treatment, with many patients achieving long-term cancer control or cure, particularly when the disease is caught before spreading beyond the bladder. For muscle-invasive bladder cancer, cystectomy provides good survival rates compared to bladder-preserving treatments alone.

The procedure eliminates the source of troublesome symptoms such as severe bleeding, frequent urinary infections, and pain associated with bladder tumours. Many patients experience improved quality of life once they recover and adapt to their urinary diversion. Modern surgical techniques and urinary diversions allow many patients to maintain active lifestyles, including work, travel, and recreational activities. For those with neobladders, the ability to urinate nearly normally preserves body image and lifestyle significantly.

Consulting an experienced urologist in Singapore ensures appropriate surgical planning, optimal recovery, and personalised post-operative care. Cystectomy also provides peace of mind by removing the ongoing worry about cancer progression in the bladder. The comprehensive lymph node dissection performed during surgery provides crucial staging information that guides additional treatment decisions if needed.

Common Side Effects

Most patients experience temporary fatigue and weakness that improves over several weeks. Bowel function changes, including temporary ileus (slow bowel function) or altered bowel habits, are common but usually resolve. Sexual function changes occur in many patients, with men potentially experiencing erectile dysfunction and women experiencing vaginal changes. Urinary incontinence affects some neobladder patients initially but often improves with pelvic floor exercises. Stoma-related issues like skin irritation or proper appliance fit may require adjustment in ileal conduit patients. These effects are typically manageable with appropriate support and interventions.

Rare Complications

Serious but uncommon complications include anastomotic leak where intestinal connections don’t heal properly, requiring additional intervention. Blood clots in the legs or lungs occur in about 2-8% of patients despite preventive measures. Wound infections or internal abscesses may require antibiotics or drainage. Kidney function problems can develop if there’s obstruction of urine flow. Metabolic changes from using intestine for urinary diversion occasionally require long-term monitoring and management. Strictures (narrowing) at surgical connection sites may need dilation or revision surgery.

These risks are minimised through careful surgical technique, appropriate patient selection, and comprehensive post-operative care. Your MOH-accredited urologist will discuss your individual risk factors and how they can be managed.

The cost of cystectomy surgery in Singapore varies based on several factors including the surgical approach chosen, type of urinary diversion created, and length of hospital stay required. Open surgery versus minimally invasive techniques may have different cost structures. The complexity of your specific case and need for additional procedures affect the overall expense.

Costs typically include surgeon’s fees, anaesthetist charges, hospital room and operating theatre fees, medications, and medical supplies including stoma appliances if needed. Post-operative care, including follow-up consultations, imaging studies, and potential adjuvant treatments, contributes to the total treatment cost. Rehabilitation services and ongoing supplies for urinary diversion management should be considered in long-term planning.

Quality surgical care with experienced urologists can help minimise complications and reduce the likelihood of costly revision procedures. During your consultation, you’ll receive a personalised cost estimate based on your specific treatment plan.